This has been a subject of study for the past 30 years or so and it seems to be a valid question to ask. I see clients with low job satisfaction and makes me wonder to myself if a lowly mood might contribute to this person’s physical complaints. After all, unwanted stress or perceived distress might contribute to heightened sensitivity or put too much on a person’s plate.

If I am to view a client as a whole person, it would behoove me to consider ‘life factors’ or ‘psychosocial variables’ into their current presentation right? Especially since we spend so much time at work it’s a tree worth barking up on and see what the data says.

First off, what does ‘psychosocial’ mean?

‘A psychosocial factor may be defined as a measurement that potentially relates psychological phenomena to the social environment and to pathophysiological changes (1).’

So within the context of work, primary studies have looked into psychosocial variables such as perception of work, organizational aspects of work, social support at work, and stress at work and if they relate to the development of lower back pain. These types of studies are funded because the rate of work-related musculoskeletal complaints are high and drain companies of human and financial capital. So if studies like these can refine the picture on the relationship between psychosocial variables and work-related disability, then employers will try to prevent it.

These psychosocial variables were defined as follows:

  • Perception of work, including the variables job satisfaction, feelings towards work, feelings towards work conditions, enthusiasm for work, enjoyment of work, and low occupational pride.
  • Organisational aspects of work, including the variables influence on work conditions, job security, time pressure, conflicting demands, pace, work content, work control, work tempo, quantitative demands, qualitative demands, psychological demands, decision authority/latitude, skill discretion, few possibilities for on the job development, no education at employer’s expense, excessive job demands, and work monotony.
  • Social support at work, including the variables recognition and respect, social support, co-worker support, social relations, relationships at work, others listening, external support, and supervisor support.
  • Stress at work, including the variables stress, overstrain, job strain, level of distress, total mental exertion.

So what did the studies say?

A systematic review, which is a ‘group hug’ of all the available studies and determines their strength determined that the relationship between all these variables and low back pain were murky. The level of evidence, or the quality of studies, was on the low side – only 40 papers.

‘In accordance with our predetermined criteria for assessment of level of evidence and strength of association, we found moderate evidence for no positive association between perception of work, organizational aspects of work, and social support at work and LBP (lower back pain). We found insufficient evidence for a positive association between stress at work and LBP.’ 

How could this be when prior papers have proposed that there were higher association levels?

Well, the review of all the studies contradicts the conclusions seen in any single study. The methods employed for prior studies were all over the place and should be interpreted with a grain of salt.

Also, the lack of standardized definitions and operational instruments to test for psychosocial variables at work is a strong reason why the associations are just so-so. Until then, we cannot begin to get at some answers between psychological phenomena and work-related muscular issues.

If we were to digest this conclusion a bit, I’d reckon that psychosocial variables in the workplace cannot itself create organic lower back pain but perhaps can contribute to it. Perhaps if someone were predisposed to lower back pain while concurrently dealing with negative perception(s) of work, high stress, and lack of social support might amplify the acuity of lower back pain.

I assert that more studies won’t possibly find stronger associations because pain is very contextual and very subjective. Can we have someone who works at a white-collar job and experience persisting pain? Can we have someone who works the graveyard shift and stands all night feel little to no pain?

Absolutely. Lots of variables to consider.

The experience of pain and its contributors are multifactorial so it’s hard to pin down exactly what causes pain in the first place. I strongly assert this is at play here with this review.

Both physical and psychological characteristics affect people differently. The type of work, income, personality type, coping style, country, ethnicity, etc can factor into why people feel pain or not. Future research can parse these relationships out some more. Until then, biological correlations are merely speculative.


  1. Hartvigsen, J., Lings, S., Leboeuf-Yde, C., Bakketeig, L. (2003). Psychosocial factors at work in relation to low back pain and consequences of low back pain; a systematic, critical review of prospective cohort studies. Occup Environ Med 2004;61:e2 (
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